Form Follow-up Form Follow-up Form Follow-up Form

Form Approved

OMB NO. 0930-0216

Exp. Date 02/28/2013

See burden statement on reverse side

Addiction Technology Transfer Center (ATTC) Network

Follow-Up Form for Training

Participants – Please Write Your Unique Personal Code Here as Follows:
First Letter of Mother’s First Name:		First Letter of Mother’s Maiden Name:
First Digit of Social Security Number:		Last Digit of Social Security Number:
Office Use Only - ATTC Event Code:

Please check here ( ) if you have received a hard copy of this survey in the mail in error, (i.e., you did not attend the training listed above) and return the uncompleted survey in the enclosed postage-paid envelope.
PLEASE BASE YOUR ANSWER ON HOW YOU FEEL ABOUR THE SESSION NOW. How satisfied are you with the overall quality of this training?	Very Satisfied	Satisfied	Neutral		Dissatisfied	Very Dissatisfied
How satisfied are you with the quality of the instruction?
How satisfied are you with the quality of the training materials?
Overall, how satisfied are you with your training experience?
PLEASE INDICATE YOUR AGREEMENT WITH THESE STATEMENTS ABOUT THE TRAINING. The training was relevant to substance abuse treatment.	Strongly Agree	Agree	Neutral		Disagree	Strongly Disagree
The material presented in this class has been useful to me in dealing with substance abuse.
The training enhanced my skills in this topic area.
The training was relevant to my career.
The training has enabled me to serve my clients better.
This training was relevant to substance abuse treatment.
I would recommend this training to a colleague.
I would take additional training from CSAT.
I have adequate knowledge in this topic area.
I possess the skills required in this topic area.
I am currently effective when working in this topic area.
How useful was the information you received during the training?	Very Useful	Useful	Neutral		Useless	Not Applicable
Did you share any of the information from this training with others?				Yes			No
Did you share any of the materials from this training with others?
Have you applied any of what you learned in the training to your work?
20. Which of the following have been barriers to applying the information/skills learned in this training to your current job? (Check all that apply) _____ Colleagues _____ Staff resources _____ Client needs _____ Policies and procedures _____ Time _____ Need for additional training _____ Financial resources _____ Other (specify: _____________) _____ Supervisor _____ No barriers
What about the training was most useful in supporting your work responsibilities?
How can the ATTC Network improve its training?

Participants – Please Write Your Unique Personal Code Here as Follows:
First Letter of Mother’s First Name:
First Letter of Mother’s Maiden Name:
First Digit of Social Security Number:
Last Digit of Social Security Number:

Thank you for completing our survey.

Return your survey in the enclosed reply envelope if you received a hard copy of this survey.

Public reporting burden for this collection of information is estimated to average 10 minutes per response to complete this questionnaire. Send comments regarding this burden estimate or any other aspect of this collection of information to the SAMHSA Reports Clearance Officer, Room 16-105, 5600 Fishers Lane, Rockville, MD 20857. An agency may not conduct or sponsor and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. The control number for this project is 0930-0216.